How to Get Help for an Eating Disorder in Midlife

“Studies indicate increases in disordered eating and body image disturbance occurring in middle age and later adulthood in both males and females,” adds Maria Sorbara Mora, R.D., founder of Integrated Eating, a recovery program in the New York City area for people with eating disorders. Research suggests that approximately 13% of women age 50 and over have some sort of eating-disorder symptoms. And according to a 2017 study, bulimia plateaued around age 47 and binge-eating disorders continued on until after age 70.

4 Common Eating Disorders

There are a variety of types of eating disorders and any of these can show up in midlife, as well. These can include:

• Restrictive Eating Disorders and Anorexia Nervosa. People with anorexia have body-image distortion and fear of weight gain and may restrict their eating by eating very small quantities of food or only certain foods.
• Bulimia Nervosa. People with bulimia often eat in bulk and then compensate in some way, either through vomiting, use of laxatives, or other means.
• Binge Eating Disorder. People with this disorder lose control over their eating and eat large quantities of food quickly.
• Avoidant Restrictive Food Intake. Chronic dieting behaviors may fall under this category. People with this eating disorder restrict food or confine their eating to only certain types of food.

From her observations working with women in midlife, Mora finds that they are still very much susceptible to body-image issues, adding: “Many women in midlife will also chronically diet, overexercise, and have negative body image. [This] significant dissatisfaction with body changes can lead to restrictive eating disorders.”

Risk Factors of Disordered Eating in Midlife

According to Bulik, eating disorders can come from both environmental and hormonal changes in midlife.

“Environmentally, midlife is rife with transitions—children leaving home, children bounding back, caretaking of the older generation, or being sandwiched in caretaking when you have to care for aging parents at the same time as caring for young children,” Bulik explains.

Other life events that could happen in midlife like divorce, age discrimination in the workplace, and dissatisfaction with the aging process can also negatively impact self-esteem and body image, leading to potential eating disorders, says Bulik.

As for hormonal risk factors, Bulik says they can be just as tough. “Just like puberty is a risk factor [for eating disorders] in adolescent girls, perimenopause is a similarly turbulent hormonal time,” says Bulik. “Many women are completely unprepared for the changes in body shape they experience. It can all be very traumatic and difficult to adjust to.”

In both cases, Bulik says: “These experiences can lead to [coping through] extreme behaviors like diets, compulsive exercise, and body dissatisfaction which can all be a first step in developing an eating disorder. It can also exacerbate or reignite them in women with past histories or lingering symptoms.”

The Dangers of an Untreated Eating Disorder in Midlife

According to Bulik, eating disorders at any age take a toll on nearly every bodily system. But for older people, this can be more significant.

“Older adults with eating-disorder symptoms are especially vulnerable to negative consequences [of disordered eating],” says Bulik, adding that their age already puts them at greater risk of physical decline and health problems.

According to Bulik, some medical complications of eating disorders in midlife may include:

• Gastrointestinal: IBS, IBD, constipation, bloating, esophageal problems, diarrhea, nonspecific GI complaints due to starvation, binge eating and/or purging (by vomiting or laxatives).
• Dermatologic: Dry skin, thinning hair, and cracked lips from dehydration and undernutrition.
• Cardiac: Problems with blood pressure, circulation, and heart attacks from undernutrition and electrolyte disturbances resulting from purging.
• Dental: Erosion of enamel and dentin from exposure to stomach acid, caused by purging and/or poor nutrition.
• Musculoskeletal: Osteoporosis and activity-related injuries that are slow to heal because of poor nutrition and compulsive physical activity.

Older bodies can also be less resilient than younger bodies and the effects of eating disorders on the body get amplified when the person with the illness is older, says Bulik, adding that eating-disorder symptoms may also exacerbate certain medical conditions, such as cardiac disease, diabetes, and osteoporosis.

How to Get Help

If you find yourself struggling with an eating disorder in midlife, don’t be ashamed.

Betsy Brenner, 58, of Barrington, Rhode Island, is the author of The Longest Match: Rallying to Defeat an Eating Disorder in Midlife. She developed an eating disorder in her mid-40s as a result of lingering childhood trauma combined with an asthma diagnosis in adulthood. Her return to high-level tennis led to unintentional and unnecessary weight loss. "I developed an intense fear of gaining weight," she says. "Then, asthma flare-ups made me feel anxious, depressed, and out of control," Brenner adds. "I started restricting my food intake." From there, she explains, the restriction grew into something she could no longer control.

Betsy worked with a nutritionist and did years of therapy to help her get back to having a healthy relationship with food. “If I can recover, anyone can recover. But there is no shortcut,” she says.

The stress Danielle Reitinger, 44, of Phoenixville, Pennsylvania felt following losing her family home to a fire in 2016 was the catalyst for an eating disorder in her late 30s. “It was by far my most serious and most stressful life event to date and what I believe pushed me over the edge,” she says. To feel in control, she says, she started restricting her caloric intake.

“I hit rock bottom and my husband and I separated,” she explains. “I knew I needed help when the pain of my life was too much…I just wanted to numb myself to sleep.”

She vowed to herself to get help, which, for her, came from reaching out to an eating disorder recovery center. “I wanted to be better, not for anyone else but me,” she says. “I deserved a life full of joy, and happiness too.”

Resources for Dealing with Disordered Eating

Don’t feel bad if you can’t fix this on your own, says Fatema Jivanjee-Shakir, L.M.S.W. of New York City. Jivanjee-Shakir explains that it’s important to receive a mental health and medical assessment to determine what type of support is best suited to your needs.

If you are currently struggling with disordered eating and looking for help, here are some steps to take:

• Talk to your doctor. Reach out to your primary care physician. They can conduct a physical/mental examination, suggest treatment programs, and refer you to resources and specialty trained physicians that can help.
• Tell your therapist. A therapist can provide the emotional support you may need along your journey to recovery and suggest helpful resources to support your recovery.
• Reach out to an eating disorder association. Many of these have references on their websites, as well as phone and text helplines and online chat options. Try: National Eating Disorders Association (NEDA), Eating Disorder Hope, or National Association of Anorexia Nervosa and Associated Disorders (ANAD).

Jivanjee-Shakir emphasizes that there is hope for anyone with an eating disorder. “Help is available for people of all ages,” she says. “Know that recovery is possible at any developmental life stage.”

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